I fact-check my nonfiction books every so often because things change.

And this is a big change, but it makes sense. The old way to quickly evaluate someone who was hurt is Breathing, Bleeding, Broken.

The Army changed the order. This became MARCH.

Breathing, Bleeding, Broken was what I was taught and what generations of soldiers and civilians were taught after me. It is a fine sequence for a man who has collapsed in a grocery store. It is the wrong sequence for trauma, and combat medicine proved it.

MARCH is Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia.

Massive hemorrhage first. Before the airway.

The reasoning is arithmetic. A man with a severed femoral artery has somewhere in the neighborhood of three minutes. An airway problem is usually slower than that and often fixable later. If you spend ninety seconds on a jaw thrust while an arterial bleed empties onto the floor, you have done everything correctly and lost the patient.

Bleeding kills fastest and it is the most fixable thing on the list. So it goes first.

My own book had the older order — Breathing, Bleeding, Broken. What is interesting, and slightly embarrassing, is that the same chapter contains the sentence that argues against it: a person may die from arterial bleeding more quickly than from an airway obstruction. I knew. I had written it down. I just hadn’t reordered the list to match.

That is how outdated doctrine actually survives. Not by anyone defending it. By nobody getting around to renumbering it.

The H at the end matters more than people expect. Hypothermia is the last letter and it is the one that quietly kills trauma patients. A bleeding man loses the ability to regulate temperature, cold blood does not clot properly, and you get a spiral where the bleeding makes him cold and the cold makes him bleed. It does not have to be winter. A man on a warm garage floor in his own blood is losing heat into the concrete. Get something under him and something over him. Every time.

So the working sequence, for someone with no training and no equipment beyond what is in the room:

Stop the bleeding. Direct pressure, hard, with whatever cloth is at hand. If it is a limb and pressure is not working, tourniquet, tight, note the time. If it is groin, armpit, neck or shoulder, pack the wound and hold pressure for three minutes by the clock.

Then check that he is breathing and that the airway is open.

Then look for the injuries you missed, and always look for an exit wound.

Then get him off the cold ground and cover him.

Then call for help, or send someone to call while you keep working.

I always felt the best trained members on my A-Team were the medics, and this is why. Not because the procedures are complicated, but because under stress people default to the sequence they memorized, and if the sequence is wrong the training makes it worse rather than better.

That reordering is reflected in the updated The Green Beret Preparation and Survival Guide.

Learn the right order now, because you will not be reasoning it out in the moment.

The Green Beret Preparation and Survival Guide is here: https://amzn.to/3BYEq5E

To read what a survival scenario looks like and how to respond, my fiction Green Beret Survival Series is here: https://amzn.to/4nEf1XB